What is the clinical evidence from this study?

Study design: Observational. Population: Diabetes and coronary artery disease requiring percutaneous coronary intervention (n=1006). Intervention: Achieving secondary prevention targets (LDL-C <100 mg/dL and TG <175 mg/dL) vs. Not achieving secondary prevention targets (LDL-C ≥100 mg/dL and TG ≥175 mg/dL). Primary outcome: Major adverse cardiac events (MACEs) (p=0.074).

November 6, 2024Open Access

Impact of Controlling Serum Low-Density Lipoprotein Cholesterol and Triglycerides on Long-Term Clinical Outcomes in Diabetic Patients Who Have Undergone Percutaneous Coronary Intervention

Q: What are the key findings of this study?

Diabetic patients who achieved secondary prevention targets for both LDL-C and TG after PCI had a 27% incidence of major adverse cardiac events compared to 38% in those meeting neither target (P=0.074).

Key Result

Diabetic patients who achieved secondary prevention targets for both LDL-C and TG after PCI had a 27% incidence of major adverse cardiac events compared to 38% in those meeting neither target (P=0.074).

Study Design

Type

Observational (n=1,006)

Multicenter

Yes

Structured PICO

Does controlling both LDL-C (<100 mg/dL) and TG (<175 mg/dL) improve long-term clinical outcomes in diabetic patients who have undergone PCI?

Population

1,006 patients with diabetes who have undergone percutaneous coronary intervention (PCI)

Intervention

Good control of both low-density lipoprotein cholesterol (LDL-C <100 mg/dL) and triglycerides (TG <175 mg/dL)

Comparator

Poor control of LDL-C (≥100 mg/dL) and/or TG (≥175 mg/dL)

Outcome

Major adverse cardiac events (MACEs)composite

Achieving dual target levels of LDL-C <100 mg/dL and TG <175 mg/dL is associated with reduced long-term coronary events in diabetic patients following PCI.

Main Result

Absolute Event Rate: 27% vs 38%

p-value: p=0.074

Limitations

Registry study design, not conducted as a prospective cohort study.
Approximately 40% of the lipid data were from non-fasting conditions (emergency PCI cases).
Detailed follow-up data such as lipid-related parameters and medication status at the final follow-up were not collected.
Intake rates of fibrate drugs and docosahexaenoic acid-containing ω-3 fatty acid mixtures were not available.
The study did not examine non-diabetic patients.

Abstract

Background: We investigated whether patients with diabetes who had good control of both low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) would be associated with better long-term clinical outcomes after percutaneous coronary intervention (PCI). Methods and Results: Using our PCI registry (Fu-Registry), the 1,006 cases with diabetes were divided into 4 groups: Group 1, LDL-C ≥100 mg/dL and TG ≥175 mg/dL; Group 2, LDL-C <100 mg/dL and TG ≥175 mg/dL; Group 3, LDL-C ≥100 mg/dL and TG <175 mg/dL; and Group 4, LDL-C <100 mg/dL and TG <175 mg/dL. The primary endpoint during the follow-up period (median follow up of 1,984 days) was defined as major adverse cardiac events (MACEs). Additionally, all coronary events were defined as a secondary endpoint. The incidence rates of MACEs were as follows: Group 1, 38%; Group 2, 26%; Group 3, 31%; and Group 4, 27% (P=0.074), and the rates tended to be higher in Group 1. All coronary events were as follows: Group 1, 66%; Group 2, 56%; Group 3, 58%; and Group 4, 51% (P=0.032). Conclusions: In patients with diabetes who underwent PCI, the LDL-C and TG levels in Group 4 met secondary prevention targets for coronary artery disease and these patients showed better long-term clinical outcomes compared with those in other groups.

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